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CHAPTER 6

Control Panic and Claustrophobia with Vagal Braking

Becky emailed:

I have been terrified of elevators. As a nurse, I would climb ten or more flights of stairs at the hospital to avoid taking the elevator. This is part of a severe generalized anxiety disorder that resulted in years of daily panic attacks. I am fifty-two years old, and after seeing a variety of therapists over many years, this [the SOAR program] has helped me tremendously.

Carole’s experience navigating the Holland Tunnel proves that we can intentionally evoke the effects of a friend’s calming presence to manage panic. In some cases, calming signals from other people are built into our memories serendipitously. For example, even if you were scared when you first used an elevator, if you were with someone you felt physically and emotionally safe with, you likely associated that person’s presence — and their calming signals — with the elevator. Thereafter, when in an elevator, the invisible psychological presence of that person quelled your fears. Your friend’s psychological presence overrode the urge to escape and stopped the panic before it even started.

But if calming associations were not built into your brain serendipitously earlier in life, you can build them in now, as Carole did. It’s really simple. We need to find a memory of a time when you were with a person whose presence activated your parasympathetic nervous system. Do you have a friend with whom you have, at times, felt your guard let down? If so, you were unconsciously receiving signals that you were physically and emotionally safe in their presence. Feeling your guard let down is proof of full activation of the parasympathetic nervous system. If you are not sure whether you have ever experienced this feeling, let me see if I can point you to it. When you are with a friend you feel comfortable with, you may think you are completely relaxed. Unexpectedly, a ripple goes through your body, and you relax even more. That’s your guard letting down.

If you have not experienced this feeling, you can use something close to it: the memory of being with a person who, at least sometimes, did not judge you in any way. You may remember a child who was delighted to see you and ran to greet you. Other memories that may evoke the feeling are saying your wedding vows, getting engaged, cuddling a pet or seeing it running free, going fishing or playing golf with a friend, or celebrating a success with teammates.

To address the claustrophobia in an elevator, recall being with your friend. Remember their face, their eyes, their voice, and their touch. Imagine your friend is holding up a black-and-white snapshot of an elevator. Keep that in mind for a few seconds to establish a visual link between the elevator and the friend’s face. Some signals that activate your calming system are communicated in a person’s voice, so we also want to establish a vocal link. Imagine that you and your friend are looking at the snapshot together and having a conversation about it. It doesn’t matter what is said: the important thing is that you link your friend’s voice to the elevator scene in the photograph. Touch is calming, too: during this conversation, imagine that your friend gives you a reassuring touch.

Most panic-inducing situations have something in common: we feel unsafe, and escape is not immediately available. When escape is blocked, flight — our most instinctive way of dealing with panic — is compromised. After you have linked a calming memory of a friend to the experience of being in an elevator, consider other situations where escape is not immediately available such as a tunnel, a high place, a multilane highway, or a seat in a classroom, church, or theater that is not at the end of a row. All of these situations can be dealt with in the same way, by establishing calming links to them.

Everyone tries to avoid thinking about anxiety-producing situations. Set that strategy aside for a few minutes and make a detailed list of situations you find challenging. Choose one situation to work on. Think through all the parts of the experience. Link the face, voice, and touch of the calming friend to each challenging moment of the situation. Repeat this exercise daily for a week. Then choose another anxiety-producing situation, and work through that. Once you have linked all the challenging moments of each situation to the calming presence of your friend, you will no longer feel the urgent need to escape. If you have had your friend with you in a challenging situation and not felt calm, here is some good news: having your friend built inside, already linked directly to each challenging moment, provides greater calming than simply having the person with you physically but not linked to the challenges. Built inside, your friend stops the stress before you can become aware of it.

For the experience of getting in an elevator, I’ve listed some typical steps below. Your own list may be longer or shorter.

• Walking into the building

• Walking to the elevator

• Pressing the button for the elevator to come

• Waiting for the elevator

• Elevator door opening

• Seeing the elevator ready for you to get in

• Stepping into the elevator

• Selecting the tenth floor

• In the elevator; more people getting in

• In the elevator, waiting for the door to close

• Elevator door closing

• Elevator, with the door closed, not moving

• Elevator starting upward; heavy feeling

• Elevator passing the third floor

• Elevator passing the fifth floor

• Elevator passing the eighth floor

• Elevator slows its ascent; light-headed feeling

• Elevator stops; the door is still closed

• In the elevator; the door is opening

• In the elevator with someone blocking your exit

• In the elevator with no one in your way

• Stepping out of the elevator on the tenth floor

• Walking around the tenth floor

• Thinking about returning to the elevator

• Walking toward the elevator

• Pressing the button for the elevator to come

• Waiting for the elevator to arrive

• Elevator door opening

• Seeing the elevator ready for you to get in

• Stepping into the elevator

• Selecting the ground floor

• Others getting in the elevator

• Waiting in the elevator

• Elevator door closing

• Elevator door closed; not moving

• Elevator starts downward; light-headed feeling

• Elevator passing the eighth floor

• Elevator passing the fifth floor

• Elevator passing the third floor

• Elevator stopping; feeling physically heavy

• Elevator stops; the door is still closed

• In the elevator with the door opening

• In the elevator with someone blocking your exit

• In the elevator with no one in your way

• Leaving the elevator; one foot out, one foot still in

• Just outside the elevator

• Heading for the building exit

• Leaving the building

• Outside the building